Provider Demographics
NPI:1851385090
Name:WASYLIK, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:WASYLIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2919 W SWANN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4038
Mailing Address - Country:US
Mailing Address - Phone:813-877-9413
Mailing Address - Fax:813-876-0980
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-877-9413
Practice Address - Fax:813-876-0980
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2012-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0023025207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054037400Medicaid
FL054037400Medicaid
FL05324ZMedicare PIN
FL0441160001Medicare NSC